关键词: 膝关节, 骨关节炎, 胫骨高位截骨, 氨甲环酸, 止血, 围术期

Abstract: BACKGROUND: Tranexamic acid is widely used for its good hemostatic effect in orthopedic surgery, and it is the most mature application in hip and knee arthroplasties. However, the impact on perioperative blood loss of high tibial osteotomy and the risk of deep venous thrombosis is unknown.
OBJECTIVE: To explore the effect of tranexamic acid on the perioperative blood loss of high tibial osteotomy and the risk of deep venous thrombosis.  
METHODS: From June 2017 to December 2019, 76 patients with knee osteoarthritis who underwent high tibial osteotomy in the First Department of Joint Surgery of the Affiliated Hospital of Weifang Medical University were selected as the research subjects. The 76 patients were randomly divided into two groups (n=38). Tranexamic acid saline injection (1 g, 100 mL) was given intravenously 30 minutes before the operation in the trial group, and the same amount of saline was given intravenously in the control group. General perioperative data such as age, sex ratio, body mass index, hemoglobin, hematocrit, fibrinogen, prothrombin time, and activated partial prothrombin time were recorded in both groups. The two groups of patients were operated by the same group of physicians, and the internal fixation was made by the same company. The operation time, intraoperative blood loss and postoperative drainage, blood transfusion, hemoglobin and hematocrit at 1, 3, and 5 days after surgery, coagulation index at 3 days surgery, and venous thrombosis of the lower limbs at 5 days after surgery were recorded. Total blood loss, hidden and dominant blood loss were calculated. 
RESULTS AND CONCLUSION: (1) The perioperative general information was not statistically significant between the two groups (P > 0.05). There was no significant difference in the operation time between the two groups (P > 0.05). (2) The total blood loss, hidden and dominant blood loss and postoperative drainage volume in the trial group were less than those in the control group (P < 0.05). There was no significant difference in intraoperative blood loss between the two groups (P > 0.05). There was a statistically significant difference in the maximum reduction in hemoglobin and the maximum reduction in hematocrit after surgery between the two groups (P < 0.05). (3) One case in the control group was treated with blood transfusion, accounting for 3%. There was no blood transfusion treatment in the trial group, and the difference between the two groups was not statistically significant (P > 0.05). (4) There was no statistically significant difference in fibrinogen, activated partial prothrombin time and prothrombin time between the two groups at 1, 2, and 3 days after surgery (P > 0.05). (5) One case of urinary tract infection occurred in the control group after high tibial osteotomy, and no other obvious complications occurred. At 5 days after the operation, the color Doppler ultrasound of the lower extremities was reexamined. No deep vein thrombosis of the lower extremities was found in the two groups (P > 0.05). (6) It is concluded that intravenous application of tranexamic acid before high tibial osteotomy in knee osteoarthritis patients can reduce the total blood loss during perioperative period, especially the hidden blood loss, and it will not increase the risk of deep venous thrombosis of the lower extremities. 

Key words: knee, osteoarthritis, high tibial osteotomy, tranexamic acid, hemostasis, perioperative period